title: Three-dimensional high-density bipolar contact mapping of left atrial endocardial activation during sinus rhythm in patients with atrial fibrillation.
abstract: Non-contact array mapping studies have demonstrated the existence of a line of conduction block along the septopulmonary bundle area and the posterior left atrial (LA) roof during sinus rhythm (SR). However, little is known of the global LA activation pattern during SR using a high-density contact bipolar mapping system. High-density contact bipolar isochronal mapping (bipolar mapping sites: 292 [IQR 250-348] points) of the LA was performed during SR with the NavX mapping system in 20 patients with paroxysmal atrial fibrillation (AF) and 11 patients with non-paroxysmal AF. The earliest endocardial breakthrough in the the LA from the right atrium (RA) during SR occurred in the anterosuperior LA (77%) or anterior to the right pulmonary veins (23%), and the breakthrough site did not differ between patients with paroxysmal and non-paroxysmal AF. Regardless of the site of breakthrough, the LA activation pattern was homogeneous, and no line of functional block was observed in any patient. Total LA activation time was significantly longer in non-paroxysmal AF patients than in paroxysmal AF patients (95.1 ± 4.3 ms versus 78.3 ± 3.2 ms, P = 0.0040). Contact-based bipolar LA endocardial activation mapping revealed a homogeneous LA activation pattern during SR, regardless of the between-group difference in activation time and the between-patient difference in sites of earliest LA endocardial breakthrough from the RA.
authors.affiliation: Division of Cardiology, Department of Medicine, Nihon University School of Medicine.
authors.forename: Kazumasa
authors.initials: K
authors.lastname: Sonoda
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Okumura
authors.forename: Ichiro
authors.initials: I
authors.lastname: Watanabe
authors.forename: Koichi
authors.initials: K
authors.lastname: Nagashima
authors.forename: Masayoshi
authors.initials: M
authors.lastname: Kofune
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Mano
authors.forename: Rikitake
authors.initials: R
authors.lastname: Kogawa
authors.forename: Naoko
authors.initials: N
authors.lastname: Sasaki
authors.forename: Kimie
authors.initials: K
authors.lastname: Ohkubo
authors.forename: Toshiko
authors.initials: T
authors.lastname: Nakai
authors.forename: Atsushi
authors.initials: A
authors.lastname: Hirayama
mesh_terms: D000328:Adult; D000368:Aged; D001281:Atrial Fibrillation / Q000503:physiopathology*; D022062:Electrophysiologic Techniques, Cardiac; D006325:Heart Atria / Q000503:physiopathology; D006329:Heart Conduction System / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged